Improving Venous Leg Ulcer Healing Rates in a Community Hospital Outpatient Wound Clinic

Lower leg venous ulcers are among the most challenging practice issue wound care nurses face.  These ulcers affect 1-2% of adults in developed countries (Briggs & Flemming, 2007).  As the causes of these ulcers are typically chronic conditions such as peripheral vascular disease and obesity, ulcer reoccurrence is a lifelong chronic condition with cycles of ulceration.  Our clinic’s outcomes are good.  From 2005-2009 the percentage of our patients who heal within 16 weeks is approximately 95; yet, our success in healing venous leg ulcers within the same goal target is around 66%. Our staff noted patients with venous leg ulcers have difficulty adhering to the plan of care, which likely contributes to a high rate of recidivism.  

Nurses designed an initiative to apply best practice principles to improve outcomes for venous leg ulcer patients.  We utilized the AGREE evidence based practice tool (Agree Collaboration, 2001; Aass et al., 2009) and  selected the RNAO guideline Assessment and Management of Venous Leg Ulcers (2007) for implementation. With multiple stakeholders involved, we used a multi-pronged, innovative approach to integrate this guideline into practice with goals of increasing the time between clinic readmissions and reducing healing time.  We designed educational tools, embedded best practice into documentation, and emphasized prevention and post-discharge follow-up.  

To evaluate our actions, we will monitor the successful implementation of interventions for our patients with venous leg ulcers based upon the guideline, healing rates, and rate of recidivism.  We hope that our intentionally transparent integration of the evidence will improve healing rates and serve as a model for future evidence based practice changes.  Wound care nursing practice can lead the way in the facilitation of a best practice culture.